Provider Demographics
NPI:1891432597
Name:MINOR, LAURA (PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:MINOR
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5282 MEDICAL DR
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-4849
Mailing Address - Country:US
Mailing Address - Phone:210-447-7373
Mailing Address - Fax:210-444-2171
Practice Address - Street 1:5282 MEDICAL DR STE 605
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-6114
Practice Address - Country:US
Practice Address - Phone:210-271-7411
Practice Address - Fax:210-444-2171
Is Sole Proprietor?:No
Enumeration Date:2022-05-16
Last Update Date:2023-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3017688363LP0808X
TX1087904363LP0808X
TN0000095880163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100817060Medicaid